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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (03) : 231 -235. doi: 10.3877/cma.j.issn.2095-3232.2018.03.015

所属专题： 文献；

临床研究

CT/MRI在预测肝纤维化/肝硬化脾切除术后门静脉血栓形成中的价值
吴珺1, 沈敏2, 张瑶1, 王劲1, 邝思驰1,†()   
  1. 1. 510630　广州，中山大学附属第三医院放射科
    2. 510010　广州，广东省妇幼保健院放射科
  • 收稿日期:2018-03-13 出版日期:2018-06-10
  • 通信作者: 邝思驰
  • 基金资助:
    广东省医学科学技术研究基金项目(A2016099)

Value of CT/MRI in predicting portal vein thrombosis in patients with hepatic fibrosis /cirrhosis after splenectomy

Jun Wu1, Min Shen2, Yao Zhang1, Jin Wang1, Sichi Kuang1,†()   

  1. 1. Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Department of Radiology, Guangdong Provincial Maternity and Child Care Center, Guangzhou 510010, China
  • Received:2018-03-13 Published:2018-06-10
  • Corresponding author: Sichi Kuang
  • About author:
    Corresponding author: Kuang Sichi, Email:
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引用本文：

吴珺, 沈敏, 张瑶, 王劲, 邝思驰. CT/MRI在预测肝纤维化/肝硬化脾切除术后门静脉血栓形成中的价值[J]. 中华肝脏外科手术学电子杂志, 2018, 07(03): 231-235.

Jun Wu, Min Shen, Yao Zhang, Jin Wang, Sichi Kuang. Value of CT/MRI in predicting portal vein thrombosis in patients with hepatic fibrosis /cirrhosis after splenectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(03): 231-235.

目的

探讨脾切除术后门静脉血栓（PVT）形成的高危因素，并评价CT/MRI预测PVT形成的价值。

方法

回顾性分析2005年1月至2016年3月在中山大学附属第三医院因肝纤维化/肝硬化行脾切除术的179例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男148例，女31例；平均年龄（44±12）岁。采用CT/MRI诊断PVT，并测量脾脏体积和门静脉直径。根据术后PVT形成与否将患者分为PVT组（77例）和对照组（102例）。采用单因素分析及多因素Logistic回归分析PVT形成的独立危险因素。根据患者脾脏体积和门静脉直径分布情况确定CT/MRI对PVT形成风险的预测价值。

结果

多因素Logistic回归分析显示，术前脾脏体积、门静脉直径、PT，手术方式及手术前后Plt差值ΔP7、ΔP14为PVT形成的独立影响因素（OR=4.563，4.443，4.369，3.094，2.117，1.378；P<0.05）。术前脾脏体积≥1 100 cm3、门静脉直径≥17 mm时脾切除术后PVT形成风险明显增加（χ2=25.470，16.820；P<0.05）。

结论

影响单纯性肝纤维化/肝硬化患者脾切除术后PVT形成的因素多且复杂，术前CT/MRI测量脾脏体积及门静脉直径能够为预测PVT形成风险提供重要的参考依据。

关键词: 体层摄影术，螺旋计算机, 磁共振成像, 肝硬化, 脾切除术, 血栓形成, 门静脉
Objective

To investigate the high risk factors of portal vein thrombosis (PVT) after splenectomy and to evaluate CT/MRI in predicting PVT formation.

Methods

Clinical data of 179 patients with hepatic fibrosis/cirrhosis who underwent splenectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2005 to March 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 148 males and 31 females with the mean age of (44±12) years old. PVT was diagnosed by CT/MRI and the volume of spleen and the diameter of portal vein were measured. The patients were divided into PVT group (n=77) and control group (n=102) according to the formation of PVT or not after operation. Single factor analysis and multivariate Logistic regression were used to analyze the independent risk factors of PVT formation. The predictive value of CT/MRI for the risk of PVT formation was determined according to the distribution of spleen volume and portal vein diameter of patients.

Results

Multivariate Logistic regression analysis showed that preoperative spleen volume, portal vein diameter, PT, operative procedure and the D-value of pre- and post-operative Plt ΔP7 and ΔP14 were the independent influencing factors of PVT formation (OR=4.563, 4.443, 4.369, 3.094, 2.117, 1.378; P<0.05). The risk of PVT formation after splenectomy increased significantly when the preoperative spleen volume was≥1 100 cm3 or the portal vein diameter was≥17 mm (χ2=25.470, 16.820; P<0.05).

Conclusions

There are many complicated factors affecting PVT formation after splenectomy in patients with simple hepatic fibrosis/cirrhosis. Preoperative CT/MRI measurement of spleen volume and portal vein diameter can provide important information in predicting the risk of PVT formation.

Key words: Tomography, spiral computed, Magnetic resonance imaging, Liver cirrhosis, Splenectomy, Thrombosis, Portal vein
表1 PVT形成影响因素Logistic多因素回归分析
临床参数 b Waldχ2值 P值 OR 95%CI
脾脏体积 1.491 4.892 0.013 4.563 1.568～23.451
门静脉直径 1.567 4.599 0.032 4.443 1.137～17.360
PT 0.720 2.548 0.023 4.369 3.586～11.231
ΔP7 1.129 5.145 0.013 3.094 4.567～10.489
ΔP14 0.750 0.738 0.014 2.117 1.369～9.415
手术方式（断流术） 0.321 4.523 0.041 1.378 2.128～10.387
表2 术前脾脏体积和门静脉直径与PVT形成关系（例）
组别 例数 脾脏体积 门静脉直径
<1 100 cm3 ≥1 100 cm3 <17 mm ≥17 mm
PVT组 77 32 45 23 54
对照组 102 80 22 62 40
χ2值 ? 25.470 16.820
P值 ? <0.05 <0.05
图1 PVT组和对照组患者脾脏体积分布的情况图
图2 PVT组和对照组患者门静脉直径分布情况图
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